[DOCTOR’S ORDERS] Beware of Racial Bias in Pediatric Care

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman,” Dr. Martin Luther King, Jr. proclaimed to an audience of physicians at the 1966 National Convention of the Medical Committee for Human Rights.

Many of us who are immersed in daily conversations about health injustice are familiar with ample scientific reports that have exposed differences in the treatment of Blacks versus non-Blacks. Often, these differences have been linked to less than optimal care and are believed to contribute to the overall poor health of Blacks.

However, in a recent study published in Pediatrics, differences in antibiotic treatment appear to benefit Black children instead of harm them. The study, which analyzed over 1.2 million patient encounters, reports that Black children are less likely to be prescribed antibiotics than non-Black children. Non-Black children (29.5%) were more likely to end up with an antibiotic prescription than Black children (23%) from the same physician.

Why would this be viewed as positive? Antibiotics are powerful medicines that are used to cure many infections by killing or slowing the growth of bacteria. They do not kill viruses. This is important since children get a lot of upper respiratory tract infections caused by viruses such as colds, the flu, sore throats (except strep throat which is caused by bacteria), and most coughs do not require antibiotics. The authors of the study propose that the Black children are possibly being treated appropriately considering current guidelines for antibiotic use.

To the contrary, the non-Black children may be receiving antibiotics too often according to the study authors. When certain antibiotics are used too often, they can become ineffective. This is called antibiotic resistance. These resistant strains of bacteria can be very difficult to treat. For this reason, physicians have been given guidelines to think twice when prescribing antibiotics especially to children.

The authors suggest that one reason for over-prescribing by the physician may be that non-Black parents ask the physician to prescribe antibiotics more often than Black parents. However, this is speculation.

Another study result found that when an antibiotic was prescribed Black children were less likely to receive broad-spectrum antibiotics than non-Black children. Broad-spectrum antibiotics act against a wide range of diseases and have a greater chance of creating resistant bacteria. On the other hand, narrow spectrum antibiotics kill very specific types of bacteria and are less likely to create resistant bacteria.

Do these findings mean good news for Black children? Not enough is known yet. Whether results are for the good or bad, these children are still being treated differently based on their skin color. Differences in treatment based on race should always raise eyebrows and begs for further investigation.

Physician racism and bias are well-documented factors that potentially contribute to health inequities that exist for Blacks.

· In 1999, the New England Journal of Medicine published a landmark study. After viewing videos of individuals of different races and gender, physicians were asked how they would manage the individual’s care with chest pain. Blacks were less likely to be referred by the physician for cardiac catheterization, the recommended standard of care at the time, even though Blacks presented with the same symptoms, age, and follow-up test results as Whites.

· Commissioned by the United States Congress, the Institute of Medicine (IOM) published in 2002 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health and found that racial disparities in health persist even when insurance status, income, age, and severity of disease are similar, and that physician and health provider racism and bias, along with other reasons, were possible contributors.

· Harriet Washington, an author and researcher from Harvard University, also chronicled in her 2007 book, Medical Apartheid, the long-standing history of the systemic mistreatment of blacks in healthcare from slavery to modern-day America.

Blacks suffer from a greater burden of disease than non-Blacks. Therefore, constant probing is required by the medical community to unveil and address inequalities in health just as Dr. Martin Luther King, Jr. challenged America to dismantle the structural reasons for social inequalities.

In the meantime, it remains important for parents and caregivers to be strong advocates who always ask questions and voice concerns when navigating the healthcare system for their children.